The #1 Objective for Use of Restraints

One. Objective. Only. Restraints are to be used only as an intervention that helps the patient regain behavioral control in order to maintain patient and staff safety.

Period. Drop the mic. That's it. There is no other reason allowed for using restraints on a patient.

And the moment behavioral control has been regained, the restraints must come off.

The patient does NOT need to have regained control over their emotions. They may still be angry or sobbing. But if they can contract for behavioral control--no hitting, no throwing items, no spitting at others, etc.--then the restraints come off. They don't need to be calm for restraints to be discontinued.

Also, the patient does NOT need to have regained control over their thoughts. They may still think a rule is stupid, that they don't need to be hospitalized, or that we are all morons. They are allowed to have thoughts that are not based in reality. Thoughts themselves do not put anyone's safety at risk.

"But Alison, what if they tell us they want to kill a staff member?" That is a very serious threat to safety, no doubt about it, but it is not responded to with restraints. It's dealt with by initiating the Tarasoff Rule (AKA, Duty to Warn)., if necessary, and safety measures have to be put into place (such as a 1:1 on the threatening patient or placing the threatened staff member on another unit for a time.) But it is illegal to place the patient in restraints for verbal threats.

""What if they don't apologize for throwing a table across the room and breaking it?" Doesn't matter. Apologies are not a requirement for having the restraints discontinued. If they have regained control and verbally state they understand that they cannot do things that put others in harm's way and will follow that rule, they come off.

"But what if we remove the restraints and as soon as they're free and all restraints have been removed, they try to punch a staff member?" You're not going to like this answer, but...if the first episode concluded and the patient was entirely free of restraints, you have to initiate another episode of restraints, including all the phone calls and all the paperwork that go with putting someone in restraints. And since the patient has shown a lack of trustworthiness, trusting their promises or reassurances that they are back in control of their behavior is unwise. At this point, a discussion about medication would probably be appropriate as a way of ensuring the patient's behavior is no longer a risk to self or others.

In summary: the only way restraints can be used legally is for keeping the patient and those around that patient safe. Once safety has been re-established (i.e., the patient has regained control over their behavior or the patient's behavior is no longer threatening to self or others), the restraints are discontinued.

Any questions on ANCC's PMH-BC exam about restraints will likely be around issues like appropriateness of initiating or maintaining restraints on a patient, or on the proper procedures once restraints have been started. Be sure you know those laws!

Want to pass ANCC's Psychiatric-Mental Health Exam on the first try? We have all the resources you'll need! Check us out at pmhrn.com.